7/12/15 Aaqid Akram MBChB (2013) Liberty-Breeze Heskeymee-Preston Answers Anonymous 7/12/15 Aaqid Akram MBChB (2013) Liberty-Breeze Heskeymee-Preston

Agenda What is the difference between osteoporosis and osteomalacia? How do you clinically differentiate DVT from cellulitis? Conn’s syndrome – How does it cause polyuria and hypertension? Management of acute respiratory conditions

Osteoporosis Progressive systemic skeletal disease Reduced mass – low bone mineral density – normal mineral:matrix Bone more fragile + susceptible to fractures Increased risk Age Female Steroids (3 months) Low BMI Alcohol / smoking Normal enough bone, just not enough of it! Normal 1 SD Osteopenia 2.5 SD Osteoporosis >2.5 SD Require DEXA scan of hip and dependent on standard deviations below the young adult reference mean. Imbalance between osteoclasts and osteoblasts working.

Osteomalacia Inadequate mineralisation of bone matrix Severe vitamin D deficiency Found in diet (oily fish, liver, egg yolk, fortified breakfast cereals) Precursor in skin following exposure to UV light (90%) GI malabsorption / Liver disease / Kidney disease / anticonvulsants Hydroxylation: liver + kidneys  1,25 dihydroxyvitamin D3 Required for calcium absorption 20-30 mins of exposure to face and forearms 3 times a week (Caucasian) Pain + proximal muscle weakness Soft bone – reduced mineral:matrix Loss of skeletal mass caused by inadequate mineralisation of the normal osteoid tissue after the closure of the growth plates. Rickett’s is the same process before closure of growth plates.

DVT vs Cellulitis Very similar signs and symptoms Severe DVT may mimic cellulitis / may occur simultaneously Cellulitis Smaller area affected, but more pronounced features Well defined margins May see entry point Fever DVT Deep vein distribution Well’s Score – Cancer / reduced mobility / calf size / previous DVT Differentiating tests: FBC / USS / (NOT D-DIMER) Don’t forget about baker’s cyst: herniation of synovial membrane of knee joint

The Adrenal Gland Mineralocorticoids Aldosterone Glucocorticoids Zona Glomerulosa Mineralocorticoids Aldosterone Zona Fasciculata Glucocorticoids Cortisol Zona Reticularis Androgens / Oestrogens Testosterone / DHEA (Oestrogen precursor) Medulla Catecholamines Adrenaline / noradrenaline DHEA = didehydroepandidrosterone

Aldosterone Angiotensin II / Extracellular K+ / ACTH Distal convoluted tubule / collecting duct Reabsorbs Na+ Excretes K+ / H+ Hyperaldosteronism Hypertension Hypokalaemia Downregulation of aquaporins in collecting duct Unable to concentrate urine Loss of hydrogen ions Metabolic alkalosis 1o = Adenoma (Conn’s) / hyperplasia 2o = Renin angiotensin aldosterone (RAA) overactivity

Cortisol ACTH (Ant. Pituitary) Increases metabolism Hyperadrenalism Releases amino acids + lipolysis Gluconeogenesis Inhibits glucose uptake by cells Raises blood glucose levels Increases cardiac muscle contractions Water retention Anti inflammatory / anti allergenic effects (Immunosuppression) Hyperadrenalism Cushing’s syndrome (Cushing’s disease = pituitary adenoma)

Adrenal Insufficiency May affect cortisol and aldosterone release 1o = adrenal gland dysfunction 2o = pituitary dysfunction Tumour Congenital adrenal hyperplasia Autoimmune May lead to adrenal crisis Inability to release cortisol in response to stress Hypotension and shock

Management of acute respiratory conditions Now to Liberty Breeze to tell you about respiratoy conditions. Please only provide feedback for Liberty Breeze on the feedback for sessions part.